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\nRequest form for the exchange of information on marketing authorisation holders or manufacturing authorisation holders between the competent authorities in the EEA  \nTable of contents:  \n1. Union format for a request form for the exchange of information on marketing authorisation holders or manufacturing authorisation holders between the competent authorities in the EEA  \nTitle  \nDate of adoption  \nDate of entry into force  \nSupersedes  \nReason for  \nrevision  \nNotes  \nLast publication date:  \nDocument version  \nRequest form for the exchange of information on marketing authorisation holders or manufacturing authorisation holders between the competent authorities in the EEA  \nMay 2012  \nBy 2 January 2013  \nNew  \nNew  \nNot applicable  \n1 August 2024 1  \nRequest form for the exchange of information on marketing authorisation holders or manufacturing authorisation holders between the competent authorities in the EEA  \nThe templates below were developed in order to facilitate exchange of information between the competent authorities in EEA where there are no established procedures or systems (e.g. EudraGMDP) for the exchange of information  \n\n| Reference no. : | No. of pages/No. of attachments: | Date: |\n| --- | --- | --- |\n\nRequesting Competent Authority  \n\n| Competent Authority/ Country |  |\n| --- | --- |\n| Address/phone/fax |  |\n| Contact Person |  |\n| Email of Contact Person |  |\n\nRecipient Competent Authority  \n\n| Competent Authority/ Country |  |\n| --- | --- |\n| Address/phone/fax |  |\n| Contact Person |  |\n| Email of Contact Person |  |\n\nRequest for Exchange of Information on [complete as appropriate]  \n\n| MAH-Address/phone/fax/Email |  |\n| --- | --- |\n| QPPV/ PSMF site – Address/phone |  |\n| Medicinal Product/dosage form/strength/INN/MA |  |\n| Manufacturer\u003Cbr>Address/phone/fax/Email |  |\n| Information requested |  |\n\nReply form in response to a request for the exchange of information on marketing authorisation holders or manufacturing authorisation holders between the competent authorities in the EEA  \nAs requested by the competent authority of   on ....../ /  (Original [Ref. no .............](Ref. no .............). ),  \nthe competent authority of   confirms the following information:  \nThe MAH and/ or QPPV/PSMF or the Manufacturer (delete as appropriate)    \n……………………………………………………………………………………………………………………………………………………………………….  \n(Medicinal Product/dosage form/strength/INN/MA)   Address    \n………………………………………………………………………………………………………………………………………………………………………  \n………………………………………………………………………………………………………………………………………………………………………  \n………………………………………………………………………………………………………………………………………………………………………  \n………………………………………………………………………………………………………………………………………………………………………  \n………………………………………………………………………………………………………………………………………………………………………  \n………………………………………………………………………………………………………………………………………………………………………  \n………………………………………………………………………………………………………………………………………………………………………  \n………………………………………………………………………………………………………………………………………………………………………  \n………………………………………………………………………………………………………………………………………………………………………  \n………………………………………………………………………………………………………………………………………………………………………  \nName and signature of a responsible officer of the reporting competent authority:  \n  Date:","cbCain0b6uQ7zJeR","https://ap.wps.com/l/cbCain0b6uQ7zJeR","pdf",185753,"English","# Union format for a request form for the exchange of information\n## Title\n## Date of adoption\n## Date of entry into force\n## Supersedes\n## Reason for revision\n## Notes\n## Last publication date\n## Document version\n# Requesting and recipient competent authority details\n## Requesting competent authority\n## Recipient competent authority\n# Request for exchange of information\n## MAH/QPPV/PSMF and manufacturer identification\n## Information requested\n# Reply form in response to a request\n## Confirmed information and responsible officer signature","[{\"question\":\"What is the purpose of this request form?\",\"answer\":\"It facilitates the exchange of information between competent authorities in the EEA when established procedures or systems for exchanging information are not available.\"},{\"question\":\"Which parties and roles can be covered by the exchange request?\",\"answer\":\"The request can cover a marketing authorisation holder (MAH) and/or QPPV/PSMF site, or the manufacturer, as indicated by the completed fields (with wording for deleting as appropriate).\"},{\"question\":\"What information must be provided in the request?\",\"answer\":\"The form collects identification and contact details for the requesting and recipient competent authorities, as well as MAH/QPPV/PSMF site and medicinal product or manufacturer data, followed by a dedicated section to specify the information requested.\"}]","Request form for the exchange of information on marketing authorisation holders or manufacturing authorisation holders between the competent authorities in the EEA - template | PDF",1789850095]